Misdiagnosis teaching and assessment tool

James Navin jnavindr at AOL.COM
Mon Jul 29 23:23:05 UTC 2013


All you have to do is reflect upon your own behavior in this business. Mistakes are frequent and you just have to be honest with yourself about yourself. 

EVERYBODY MAKES MISTAKES BUT ARROGANCE HELPS TO HIDE THEM.

Take the example of the lady with previous breast CA and radical mastectomy who develops a mass in the axilla. The radiotherapist sends her to the original surgeon who tells her "I never leave any nodes behind." Patient says, "But I have this mass." he pulls his hearing aid machine from his pocket and turns it off. He examines her and sends her home--He does not examine the axilla.

Radiotherapist calls me--a younger associate surgeon tells me, "Send her in on Saturday--He won't be here and I'll take care of it." He did
Remember the HODADS.

jn


-----Original Message-----
From: robert bell <rmsbell at ESEDONA.NET>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Mon, Jul 29, 2013 1:03 pm
Subject: Re: [IMPROVEDX] Misdiagnosis teaching and assessment tool


Knowing if humility was related to accuracy in diagnosis would be very welcome.

How would you define humility?

Rob
On Jul 29, 2013, at 11:38 AM, Graber, Mark wrote:

> Bob's comments are perfect:  Ehud's project meets all of the key elements of 
effective feedback: timely, relevant, non-judgmental and actionable.
> 
> Ehud's experiment seems like an ideal model that other training programs could 
follow.  The most powerful teaching tool is to see your own mistakes.  With 
autopsies now a historical relic in most countries, this kind of real-time 
experience seems like an ideal replacement.
> 
> Just wondering though, if students who DIDN'T make the diagnostic error go on 
to be overconfident about their abilities (or less reflective) than the ones who 
did.
> 
> Mark
> 
> 
> Mark L Graber, MD FACP
> Senior Fellow, RTI International
> Professor Emeritus, SUNY Stony Brook School of Medicine
> Founder and President, Society to Improve Diagnosis in Medicine
> Phone:   919 990-8497
> 
> 
> ________________________________
> From: Bob Swerlick <rswerli at GMAIL.COM>
> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, 
Bob Swerlick <rswerli at GMAIL.COM>
> Date: Sun, 28 Jul 2013 12:05:38 -0400
> To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] Misdiagnosis teaching and assessment tool
> 
> Yes, it is all about providing feedback in a time frame that is relevant. The 
challenge in medicine is that this does not happen in any meaningful way in the 
outpatient setting. The feedback physicians and trainees often receive is simply 
about money and clinical volume, with a few "quality" metrics salted in. At this 
point in time they are generally selected because they can be measured as 
opposed to have have real meaning.
> 
> We may be able to identify specific exercises within a training environment 
where trainees can receive important feedback, and Dr. Zamir needs to be lauded 
for his insight and clever approach. Perhaps as trainees are enlightened as to 
the power of real time feedback a cultural change may come about with similar 
inroads being made in the world of every day practice. We can hope but at this 
point our cutting age feedback tools are Press Ganey surveys which tell us 
whether our patients are happy or unhappy.
> 
> 
> On Sat, Jul 27, 2013 at 9:27 PM, Ehud Zamir <ezamir at unimelb.edu.au> wrote:
> I have recently conducted an experiment where real patients volunteered to be 
examined by senior ophthalmology residents in a mock clinical exam. Several 
cases were chosen because they had a history of (usually harmless) misdiagnosis, 
but were presented to the trainees just as they had presented to the doctor, 
with (erroneous) presumptive diagnoses from previous doctors or with other 
contextual/cognitive biases. In the vast majority of cases, trainees 
misdiagnosed them exactly in the same way it had been done by the original 
doctors, namely stumbled on the cognitive biases or contextual misleading 
information inherently present in the cases.  I found this a good way to teach 
about diagnostic error, as it is not just a list of theoretical biases. It is a 
very authentic simulation. Trainees are in fact led towards making a diagnostic 
error (similar to the original doctor) and made the error in a controlled 
environment, then received feedback and "learned the lesson". In addition to a 
good teaching model about diagnostic errors, I also believe it is a very useful 
method for assessment of diagnostic skills. A bit difficult logistically 
(finding patients with a history of misdiagnosis who still have the findings) 
but certainly feasible. If we value the skill of diagnosis, we have to test it 
in authentic conditions, and in the presence of proven misleading factors. 
Lessons learnt from misdiagnosis should be used for training and assessment in a 
concrete manner.
> 
> Ehud Zamir
> Centre for Eye Research Australia
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> 
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for 
Improving Diagnosis in Medicine
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> 
> --
> Bob Swerlick
> 
> ________________________________
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> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for 
Improving Diagnosis in Medicine
> 
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> 
> Save the date: Diagnostic Error in Medicine 2013. September 22-25, 2013 in 
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> 
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> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for 
Improving Diagnosis in Medicine
> 
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Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for 
Improving Diagnosis in Medicine

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